Abstract: Chronic pain and prescription opioid use are highly prevalent among American Indians but culturally appropriate interventions for the treatment of chronic pain do not exist for any tribal community in the United States. To address this important health disparity, tribal leaders of the Fond du Lac Band of the Lake Superior Chippewa initiated a partnership with Mayo Clinic to improve the care of approximately 1 in 5 American Indians with chronic pain who receive primary care services in the tribal owned health delivery system. The overall objective of this project is to culturally adapt an efficacious cognitive behavioral intervention for adult American Indians with chronic pain. The conceptual basis for this proposal is social cognitive theory. During Aim 1, an efficacious cognitive behavioral intervention will be culturally adapted for implementation in the health delivery system of the Fond du Lac Band. This aim will employ communitybased participatory research methods, including individual informant interviews and focus groups, involving American Indians with chronic pain, providers with expertise in caring for American Indians, and clinicians with expertise in chronic pain to culturally adapt the inten/ention. The intervention will be pilot tested in 20 adults. Following pilot testing, the intervention will then be further refined based on participant and provider feedback, focusing specifically on the cultural sensitivity and appropriateness of the inten/ention. The goal of this aim will be to refine and assess the acceptability of the clinical components of the intervention and to start training the tribal medical and allied health staff members to deliver the intervention. During Aim 2, a formal evaluation of the intervention will be conducted using a randomized wait-list control design. The primary outcome will be the change in pain severity from baseline to week 13 after initiation of treatment. Potential predictors of treatment effects will be assessed including prescription opioid use. At project conclusion, the tribal-led partnership will have adapted and tested the first culturally appropriate intervention for American Indians with chronic pain, and will have the potential for widespread dissemination to other tribal organizations throughout the United States.Tribal leaders of the Fond du Lac Band initiated a partnership with Mayo Clinic to improve the care of approximately 1 in 5 American Indians with chronic pain who receive primary care services in the tribal outpatient facilities. The overall objective of this project is to culturally adapt an efficacious cognitive behavioral intervention for adult American Indians to reduce existing health disparities in chronic pain.